New {Anatomy/ Lec 6}————Thyroid gland / part 2Edited by : Rua’a … · 2020. 5. 9. · * Thyroid gland has to migrate from site of origin [ between future parts of tongue]

{Anatomy/ Lec 6}————Thyroid gland / part 2

Edited by : Rua’a Nader

4/29/2020 Dr.Shatarat

with development of the arches and clefts,

a number of outpocketings,

The pharyngeal

pouches appear

THE PHARYNGEAL ARCHES

are separated

by deep clefts known as

PHARYNGEAL

CLEFTS

In a cross section of the embryo in the area of the head and neck

The following can be noticed

THE PHARYNGEAL ARCHES


* This is an embryo in (4th-5th) weeks of development.

Tuberculum impar

Copula

(hypobranchial

eminence

Epiglottal

swelling

Palatine

tonsil

Root of

tongue

Foramen

cecum

in th

e floo

r of t

he ph

aryn

x


* We need to focus on the floor of the pharynx , [ that’s area where the thyroid gland should arise from ] .

Related to the 1st pharyngeal arch

Related to 2nd , 3rd & 4th arches

** Read only !

* Just to be familiar with some names rather than the development of the tongue .

* The 2 lateral swellings would unite with Tuberculum impar —> forming the ant. 2/3 of tongue occupying the mouth proper. * Sensory innervation : branch of mandibar nerve —> lingual nerve .* Also , Copula meets the Tuberculum impar & lateral swellings (the ant. 2/3 of tongue) . * Mainly 3rd pharyngeal arch will form post. 1/3 of the tongue that’s located in oropharynx and nearby should be palatine tonsils in lateral sides ( supplied by glossopharyngeal nerve ).* The 2nd arch will disappear and it left innervation of taste buds in tongue by facial nerve . * Motor nerve supply to the tongue —> Hypoglossal nerve * When ant. 2/3 & post. 1/3 meet each other, it would form —> Sulcus terminalis & foramen cecum .

Pharynx (ventral view) 4th week

Thyroid Gland1-begins to develop during the

third week as an endodermal thickening in the floor of the

pharynxbetween the tuberculumimpar and the copula at a

point later indicatedby the foramen cecum


* The ultimate position of thyroid gland is in the neck .* Thyroid gland has to migrate from site of origin [ between future parts of tongue] down to reach the lower part of the neck .

2- It descends in front of the pharyngeal gut as a bilobed diverticulum

3- During this migration, the thyroid remains connected to the tongue by a narrow

canal, the thyroglossal duct.


* If there’s migration from one area to another (to ensure that this migration would take it in a proper place at the end of this journey, so you need something to help [ a canal ] , like in migration of testis from the abdomen to scrotum . This canal has a connection between the site of origin [where the thyroid gland has appeared at the first place] until it’s reaching the final position [ lower part of the neck or Trachea] .

4-As development continues, the duct elongates, and its distal end becomes bilobed. Soon,

the duct becomes a solid cord of cells, and as a result of epithelial proliferation, the bilobed

terminal swellings expand to form the thyroid gland

5-The thyroid gland now migrates inferiorly in the neck and passes either anterior to, posterior to,

or through the developing body of the hyoid bone.

6-By the seventh week, it reaches its final position in relation to the larynx and trachea.

Meanwhile, the solid cord connecting the thyroid gland to the tongue fragments and

disappears. 4/29/2020 Dr.Shatarat

# Very important co’z it has clinical application

(The whole duct should be closed and the connection between the tongue & thyroid gland should be lost)

* During pregnancy , if pregnant female has been exposed to many different conditions —> this migration may stop & therefore it’s very important to understand the exact path of migration ; ex. Testis . So , if you know the path , you would expect where to look and it’s important to know areas where thyroglossal duct passes through.

7-The site of origin of the thyroglossal duct on

the tongue remains as a pit called

the foramen cecum.

8-The thyroid gland may now be

divided into a small median isthmus

and two large lateral lobes

Pharynx and derivatives (between 6th and 7th weeks)4/29/2020 Dr.Shatarat

is closed , and this foramen should be a reminder for you to tell you that thyroid gland was there .

9-The ultimobranchial bodies (from the fifth pharyngeal pouch) and

neural crest cells are believed to be incorporated into the thyroid gland,

where they form the parafollicular cells, which produce

calcitonin.

Second origin of the thyroid gland

as we mentioned before, most glands have two different origins


* this part is not endodermal in origin, rather than it’s neural crest that has settled in 5th pharyngeal arch & participate in formation of thyroid gland .

* The histology of thyroid gland consists of : Follicles [ endodermal in origin ] sandwiched between them interstetial ( parafollicular cells ) . >> not inside the follicle —> co’z it’s from different origin .

Congenital Anomalies of the

Thyroid Gland

1-Agenesis of the Thyroid

Failure of development of the thyroid gland may occur and

is the commonest cause of cretinism

2-Incomplete Descent of the Thyroid

The descent of the thyroid may be arrested at

any point

between the base of the tongue and the trachea

Lingual thyroid is the most common form of

incomplete

descent The mass of tissue


* In this case , you wouldn’t see foramen cecum since it’s a reminder when the thyroid gland has left down .

Aberrant thyroid tissue may be found anywhere along the path of descentof the thyroid gland. It is commonly found in the base of the tongue,

just behind the foramen cecum, and is subject to the same diseases as thethyroid gland itself.

caution!!!A mass in the

posterior midline might be the only

thyroid in the patient’s body


* Sometimes , of course perfectly functioning but maybe patient complains about it .

Thyr

oglos

salD

uct a

nd Th

yroid

Abn

orm

alitie

s


Don’t memorize this ! but , understand the thyroid gland if to be arrested in descending down, you need to look for it at these positions from the tongue until it reaches trachea . * most common one : Lingual

3-Persistent Thyroglossal Duct

Conditions related to a persistence of

the thyroglossal duct

usually appear in childhood, in

adolescence, or in young

adulthood


* The thyroglossal duct did not close . * Always we think about thyroid gland as a midline structure.

Thyroglossal Duct and Thyroid Abnormalities

A thyroglossal cyst may lie at any point along the migratory pathway of the

thyroid gland but is always near or in the midline of the neck

by its name, it is a cystic remnant of the thyroglossal duct, Although

approximately50% of these cysts are close to or just

inferior to the body of the hyoidbone they may also be found at the base

of the tongueor close to the thyroid cartilage. Sometimes a thyroglossal cyst is

connected tothe outside by a fistulous canal, a thyroglossal fistula. Such a fistula

usuallyarises secondarily after rupture of a

cyst but may be present at birth.4/29/2020 Dr.Shatarat

Thyroglossal cyst. These cysts, which are

remnants of the thyroglossalduct, may be

anywhere along the migration pathway of

the thyroid gland. They are commonly

found behind the arch of the hyoid bone. An important diagnostic

characteristic

is their midline location.


* if a child with a midline mass , you need to think about thyroid gland, you should expect that it has to be in it’s normal position [ lower part of the neck]* To examine the patient’s neck , you need to pay attention to important things : 1- if the mass in the lower neck and you ask the patient to swallow and thyroid gland goes up & down with swallowing movement, it means this is a mass that related to thyroid gland . 2- if a patient complaining from midline mass in upper part of the neck, it may related to congenital anomalies of thyroid gland. * if Thyroid gland developed normally in its anatomical position, then we are talking about tumors, inflammation to the thyroid gland, but if it is related to it ,there will be a mass above the thyroid cartilage around the hyoid bone .

Branchial fistulas occur when the second pharyngeal arch fails to grow caudally

over the third and fourth arches, leaving remnants of the second, third,

and fourth clefts in contact with the surface by a narrow canal.

Such a fistula, found on the lateral aspect of the neck directly anterior to the

sternocleidomastoid muscle, usually provides drainage for a lateral cervical

cyst These cysts, remnants of the cervical sinus, are most often

just below the angle of the jaw

Branchial Fistulas

Frequently a lateral cervical cyst is not visible at birth but becomes evident as it

enlarges during childhood.

Patient with a lateral cervical cyst. These cysts are always on the lateralside of the neck in front of the sternocleidomastoid muscle. They commonly lie under

the angle of the mandible and do not enlarge until later in life.4/29/2020 Dr.Shatarat

* We are talking about masses of the neck, either midline or lateral

* Fistula means there’s communication with outside .

4-Thyroglossal Sinus (Fistula)

Occasionally, a thyroglossal cyst ruptures

spontaneously,

producing a sinus). Usually, this is a result of

an infection of a cyst. All remnants of the

thyroglossal

duct should be removed surgically







Metastatic disease to the thyroid is common; it

likely

relates to its rich blood supply of approximately

560 mL/100 g tissue/min (a flow rate per gram

of tissue

that is second only to the adrenal glands)


* The activity ratio of the gland & metastasis that can reach this gland

* The most active gland in terms of metastasis is Adrenal gland , secondly , Thyroid gland .


Good Luck :)

New {Anatomy/ Lec 6}————Thyroid gland / part 2Edited by : Rua’a … · 2020. 5. 9. · * Thyroid gland has to migrate from site of origin [ between future parts of tongue]

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